Varicose Veins
What are varicose veins?
Arteries bring oxygen-rich blood from your heart to
the rest of your body. Veins return oxygen-poor blood
back to your heart.
Varicose veins are swollen veins that you can see
through your skin. They often look blue, bulging, and
twisted. Left untreated, varicose veins will worsen
over time. Large varicose veins can cause aching and
feelings of fatigue as well as skin changes like
rashes, redness, and sores. As many as 4 million
Australians, most of them women, have varicose veins.
You have two kinds of veins in your legs. Superficial
veins lie close to your skin. Deep veins lie in
groups of muscles. Deep veins lead to the vena cava,
your body's largest vein, which runs directly to your
heart. Perforating veins connect superficial veins to
deep veins. Varicose veins occur in the superficial
veins in your legs.
The blood in your leg veins must work against gravity
to return to your heart. To help move blood back to
your heart, your leg muscles squeeze the deep veins
of your legs and feet. One-way valves in your veins
keep blood flowing in the right direction. When your
leg muscles contract, the valves inside your veins
open. When your legs relax, the valves close. This
prevents blood from flowing backward. The entire
process of sending blood back to the heart is called
the venous pump.
When you walk and your leg muscles squeeze, the
venous pump works well. Deep veins and perforating
veins are usually able to withstand short periods of
increased pressures. However, if you are a
susceptible individual, your veins can stretch. This
stretching can sometimes weaken the walls of your
veins and damage your vein valves. Varicose veins may
result.
Spider veins are mild varicose veins. They look like
a nest of red or blue lines just under your skin.
Spider veins are not a serious medical problem, but
they can be a cosmetic concern to some people.
What are the symptoms?
If you have varicose veins, your legs may feel heavy,
tired, restless, or achy. Standing or sitting for too
long may worsen your symptoms. You may also
experience night cramps.
You may notice small clusters of veins in a winding
pattern on your leg, or soft, slightly tender knots
of veins. Sometimes, the skin on your legs may change
color, become irritated, or even form sores.
What causes varicose veins?
High blood pressure inside your superficial leg veins
causes varicose veins.
Factors that can increase your risk for varicose
veins include having a family history of varicose
veins, being overweight, not exercising enough,
smoking or having a previous DVT. Women are more
likely than men to develop varicose veins. Varicose
veins usually affect people between the ages of 30
and 70.
Pregnant
varicose
within 1
multiple
veins.
women have an increased risk of developing
veins, but the veins often return to normal
year after childbirth. Women who have
pregnancies may develop permanent varicose
What tests will I need?
Your doctor will enquire about your general health,
medical history, and symptoms. In addition, your
doctor conducts a physical exam and will examine the
texture and colour of any prominent veins. He or she
may apply a tourniquet or direct hand pressure to
observe how your veins fill with blood. To confirm a
diagnosis of varicose veins, your physician may order
a duplex ultrasound test.
Duplex ultrasound uses high-frequency waves higher
than human hearing can detect. Your physician uses
duplex ultrasound to measure the speed of blood flow
and to see the structure of your leg veins. The test
can take approximately 30 minutes for each leg.
Besides showing varicose veins, duplex ultrasound may
help your doctor decide whether your varicose veins
are related to some other condition rather than the
veins themselves.
How are varicose veins treated?
Varicose veins will slowly worsen without treatment.
Your doctor will first try methods that don't require
surgery to relieve your symptoms. If you have mild to
moderate varicose veins, elevating your legs can help
reduce leg swelling and relieve other symptoms. Your
doctor may instruct you to prop your feet up above
the level of your heart 3 or 4 times a day for about
15 minutes at a time. When you need to stand for a
long period of time, you can flex your legs
occasionally to allow the venous pump to keep blood
moving toward your heart.
Compression Stockings
For more severe varicose veins, your doctor may
prescribe compression stockings. Compression
stockings are elastic stockings that squeeze your
veins and stop excess blood from flowing backward.
Compression stockings also can help heal skin sores
and prevent them from returning. You may be required
to wear compression stockings daily for the rest of
your life. For many patients, compression stockings
effectively treat varicose veins and may be all that
are needed to relieve pain and swelling and prevent
future problems.
When these kinds of treatments alone do not relieve
your varicose veins, you may require a surgical or
invasive treatment, depending upon the extent and
severity of the varicose veins. These treatments
include sclerotherapy, ablation, vein stripping, and
laser treatment.
Sclerotherapy
During sclerotherapy, your doctor injects a chemical
into your varicose veins. The chemical irritates and
scars your veins from the inside out. Your veins can
then no longer fill with blood. Blood that would
normally return to the heart through these veins
returns to the heart through other veins. Your body
will eventually absorb the veins that received the
injection.
Endovenous Laser Therapy (EVLT)
EVLT uses a thin, flexible laser fibre inserted into
a varicose vein. The laser fibre, when activated,
heats the walls of your varicose vein and destroys
the vein tissue. As with chemical sclerotherapy, your
vein is then no longer able to carry blood, breaks up
naturally, and is absorbed by your body.
Vein Stripping
To perform vein stripping, your surrgeon disconnects
and ties off all major varicose vein branches
associated with the saphenous vein, the main
superficial vein in your leg. Your surgeon then
removes the saphenous vein from your leg. A
procedure, called multiple stab avulsions (MSA), can
be done alone or together with vein stripping. MSA
allows your surgeon to remove varicose veins from
your leg using hooks passed through small incisions.
Although these procedures sound painful, they cause
relatively little pain and are generally well
tolerated. Your vascular surgeon will advise you
regarding which procedure is the best for your
particular situation.